The expectation of calm and prosperous intrauterine development and the birth of a baby, unfortunately, is sometimes violated by a variety of pathological processes occurring in the female body.
And one of the problems leading to spontaneous abortion in the second and third trimesters is isthmic-cervical insufficiency (ICI).
It is a shortening of the cervix, premature opening of the internal os (the so-called “muscular ring” that holds the fetus in the uterine cavity) and, as a consequence, prolapse and rupture of the membranes of the fetus with its subsequent loss.
Isthmic-cervical insufficiency and its varieties
Depending on the causes of occurrence, ICN is divided into two varieties– congenital and acquired.
Congenital ICI, as a rule, is associated with physiological defects of the uterus itself, as an internal organ (for example, with a saddle-shaped or bicornuate uterus). These developmental features require precise diagnosis, treatment, and sometimes surgical intervention even before pregnancy.
Acquired Isthmic-cervical insufficiency, in turn, is also divided into two forms:
However, it should be borne in mind that, being a foreign body, the pessary can cause vaginal dysbiosis. For prevention, it is necessary to use antiseptics or, in case of problems, antibiotics. A pessary can be installed at any time.
Surgical method for treating ICI used in cases where installing a Meyer ring is not enough. In this case, the cervix is sutured with sutures made of non-absorbable materials (most often silk surgical threads).
They allow you to narrow the internal os of the uterus. Usually this operation is performed for up to 17 weeks, but according to individual indications it can be performed up to 28 weeks.
And, of course, one of the most important components of treatment for ICI is competent and strict compliance the regimen prescribed by the doctor and avoiding any physical or psycho-emotional stress.
Childbirth with a diagnosis of isthmic-cervical insufficiency
Due to the fact that ICN is nothing more than the inability of the uterus to hold the fetus, childbirth in these cases very often proceeds quickly.
If the pregnancy is coming to an end with a favorable outcome, it is best to go to the hospital in advance. So that the situation with the onset of labor does not take you by surprise: at the wrong time, in the wrong place, and most importantly, without documents (exchange card) confirming the complicated condition of the pregnant woman.
Although treatment for ICI cannot give a completely encouraging prognosis, it is, of course, worth believing in the best. Just like fighting for the life of your child. But need to remember: It is necessary to prepare for pregnancy in advance, especially if there is at least one risk factor.
Video about pregnancy with ICN
From the video below you can get acquainted with an eyewitness's story about isthmic-cervical insufficiency and how her “lying down” pregnancy went.
Isthmic-cervical insufficiency is a pathological condition that is characterized by insufficiency of the cervix and its isthmus. As the disease progresses, the cervix becomes soft and short, and also opens slightly, which in the future can cause miscarriage. Medical statistics are such that in 30–40% of cases this disease causes premature birth, as well as spontaneous miscarriages (usually in the second trimester of pregnancy).
If pregnancy proceeds normally, then the cervix is a kind of muscular ring that prevents the fetus from leaving the cavity of the reproductive organ prematurely. As pregnancy progresses, the fetus increases in size, the amount of amniotic fluid increases, due to which the pressure in the uterine cavity increases at this time, and the load on the cervix increases. If a woman has been diagnosed with cervical insufficiency, then her cervix simply cannot cope with the increased load. Because of this, protrusion of the membranes of the amniotic sac into the cervical canal is often observed, where they can be attacked by infectious agents. After some time, they are opened, miscarried, or premature birth. Most often, miscarriage occurs after 12 weeks of pregnancy.
It is important to know that the signs of isthmic-cervical insufficiency may be completely unexpressed, so you should constantly visit a qualified gynecologist during pregnancy so that he monitors the woman’s condition and, if necessary, provides her with the necessary assistance.
Causes
The main reasons for the progression of isthmic-cervical insufficiency during pregnancy are the following:
- carrying out IVF on a woman;
- traumatization of the cervix during termination of pregnancy by surgery or by vacuum aspiration, during difficult childbirth - the most common reason manifestations of the disease;
- defects in the development of the reproductive organ;
- large fruit;
- too much amniotic fluid in the uterus;
- the presence of several fetuses in the uterine cavity at once;
- previous treatment of cervical diseases using conization;
- various functional changes that were provoked by a deficiency of sex hormones or connective tissue dysplasia;
- performing a diagnostic curettage on a woman;
- the birth of a fetus with a breech presentation;
- application of obstetric forceps during labor.
There is also functional reason manifestations in a woman during pregnancy of isthmic-cervical insufficiency - a violation of the hormonal balance, which is necessary for the normal bearing of a child. This condition is caused by hyperandrogenism and ovarian failure. If a functional form of pathology has been identified, then it can be special labor correct by prescribing the necessary medications. In the future, pregnancy will proceed without complications.
Symptoms
It is precisely because isthmic-cervical insufficiency can occur without pronounced symptoms that it can be diagnosed after a miscarriage has occurred. A woman practically does not feel any changes in the presence of this pathology, since the opening of the cervix occurs either with minor pain or even without it. In some cases, the following symptoms of ICI may be observed:
- discomfort in the lower abdomen, which can also move to the lumbar region;
- a feeling of fullness or even pressure from the lower abdomen;
- in rare clinical situations, women noted that they had stabbing pain inside the vagina;
- mucous discharge from the genital tract, often with bloody streaks.
Signs of isthmic-cervical insufficiency can be detected during a vaginal examination when a woman registers for pregnancy. During diagnostic manipulation, you can determine:
- general condition of the cervical canal. The doctor will be able to assess whether he is missing the tip of the finger or the whole thing. Normally, the walls of the cervix are tightly closed. With cervical insufficiency, free passage of the finger is noted;
- the length and consistency of the neck, and you can also determine its location;
- if the inspection is carried out in this way at later pregnancy, then you can also determine the location of the presenting part of the fetus.
The most informative is transvaginal echography, which allows you to assess both the length of the cervix and the shape of the pharynx.
Therapeutic measures
Treatment of isthmic-cervical insufficiency during pregnancy is carried out both conservatively and surgically. Sometimes it happens that doctors combine these two techniques to achieve best result. The surgical technique involves placing sutures on the neck under anesthesia, the main purpose of which is to narrow the internal os. But at the same time, the external pharynx is also sutured. When applied correctly, the risk of miscarriage is greatly reduced.
The period for intervention for each woman is determined individually. Most often, this manipulation is performed before the 17th week, but no later than the 28th. Suturing is carried out exclusively in a hospital setting and under intravenous anesthesia, which is not harmful to the fetus. Before the procedure, preparation is required. A few days before the procedure, a smear is taken from the canal to identify or refute the presence of infectious agents, and the vagina is also sanitized.
Contraindications for this type of intervention:
- the presence of developmental abnormalities in the fetus;
- non-developing pregnancy;
- the presence of severe pathologies in a woman, especially those in the acute period.
To reduce the risk of progression possible complications After the intervention, it is recommended to analyze the microflora several times and treat the vagina with various antiseptic drugs. In addition, drug therapy may be prescribed, in particular taking antispasmodics and medications that reduce the tone of the uterus.
The applied sutures are removed:
- in case of vaginal discharge mixed with blood;
- in case of childbirth;
- at 37–38 weeks of gestation;
- with slight or intense discharge of amniotic fluid.
The main method of conservative treatment is the installation of a Meyer ring. It is a small structure made of plastic. The gynecologist inserts it into the vagina. Throughout pregnancy, this ring will redistribute the weight of the growing fetus, thereby reducing the load on the cervix. The installation of the structure can be carried out at any stage of pregnancy. It is removed directly during the onset of labor or at 37–38 weeks. It is worth noting that the ring can cause the progression of dysbiosis in the pregnant woman’s vagina, so after its installation it is regularly necessary to take smears for laboratory testing. If infectious agents are detected in the analysis, then the woman must be prescribed antibacterial drugs, as well as probiotics.
Expecting a child is a period that brings moments that are not always pleasant. Weight increases, constipation occurs, and a rash appears on the body. Sometimes another significant problem becomes isthmic-cervical insufficiency.
ICI is a pathology characterized by the opening of the lower part of the uterus, which holds the fetus in the womb. During a normal pregnancy, organs grow along with the baby. If there is insufficiency, the uterus cannot function normally.
Features and symptoms of isthmic-cervical insufficiency during pregnancy
For women who were unable to get pregnant, the pathology does not pose a danger. However, if a representative of the fairer sex is carrying a child under her heart, ICI threatens to lead to the opening of the internal pharynx in the third trimester.
Statistics say that the likelihood of losing a fetus carried by a woman with isthmic-cervical insufficiency increases 16 times. Patients who suffered from this pathology at 7–9 months make up 50% of the total number of those who suffered the disease.
There are women in the world with isthmic-cervical insufficiency who were able to give birth to a child. However, such births proceed quickly. This fact can negatively affect the further development of the baby. It cannot be said that for such women childbirth goes smoothly. Injuries may occur, accompanied by heavy bleeding.
A woman will not be able to identify the disease, since for many pregnant women ICI occurs without symptoms. In rare cases, if abortions or functional curettages were performed, signs of insufficiency in the first 13 weeks resemble manifestations of other diseases:
- spotting with blood streaks;
- unpleasant sensations in the lower abdomen and lumbar region of the back.
In the later stages of pregnancy, as experts note, the following symptoms may appear:
- discharge that has increased in volume and changed consistency;
- frequent emptying of the bladder;
- pressure in the middle part of the pelvic cavity;
- distension in the perineum;
- pain under the abdomen and in the lumbar region;
- cough.
Reasons for the development of pathology during pregnancy
To make it easier to familiarize yourself with the factors for the development of pathology, a list is presented below. The disease can manifest itself due to the following reasons:
| Organic | Functional | Congenital |
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In all cases, the thinned lower segment of the uterus cannot resist the pressure of the growing baby, resulting in dilatation. The fetus continues to descend lower, the reproductive organ opens wider, miscarriage or unplanned pregnancy occurs. early birth.
Doctors note that deficiency does not always occur for only one reason. Pathology can develop as a result of the presence of several diseases.
Diagnostic methods
It is very difficult to identify a deficiency in the subject. The exceptions are indicators such as anatomical changes that occur after injuries and some developmental deviations.
Doctors note that the main indicator of ICI is a shortened lower segment of the uterus. When examining a pregnant woman, a physician may reveal flaccid edges and dilatation of the transition of the cervix into the body of the uterus. The latter easily passes the gynecologist’s finger. However, not all doctors perform genital examinations. Many people are only interested in changes in weight, abdominal volume, blood pressure and pulse. Such an incomplete examination will not help the gynecologist detect ICI and its causes, therefore it is in the interests of the pregnant woman herself to insist on a thorough examination.
According to the clinical protocol, when examining a woman, doctors should pay special attention to the location of the amniotic sac. Modern medicine distinguishes the following degrees of protrusion of membranes:
- above the upper opening of the cervix;
- at the level of the internal pharynx;
- below the top hole;
- in the organ of the internal reproductive system.
However, determining the degree of protrusion of the amniotic sac does not always help to detect an illness in the expectant mother. In primiparous women, the external os is closed, there are no signs of pathology, and risk factors cannot be identified using a gynecological instrument until childbirth.
In this situation, ultrasound will help. The results of the examination allow the doctor to refute the supposed ICI if the length of the cervix at the 6th month of pregnancy is 3.5–4.5 cm, at 7 months – 3–3.5 cm. After the 8th month of pregnancy, the length of the lower segment of the uterus should be 3 cm.
At what period can ICN cause spontaneous abortion? The threat of miscarriage or premature birth of the baby is indicated by a decrease in the length of the canal to 2.5 cm at a period of less than 28 weeks, V- or Y-shaped openings of the lower segment of the uterus and softening of its tissues. During the examination, the patient may be asked to cough so that the load on the uterus increases slightly.
The study is carried out with a transvaginal sensor. If echo signs confirm the pathology, the pregnant woman is prescribed medications. In addition, it will be necessary to monitor changes in the cervix twice a month.
It should be noted that even before pregnancy it is possible to find out whether a woman is developing the suspected pathology. To diagnose insufficiency, hysterosalpingography is done. Contrast agents are injected into the uterus and tubes and x-rays are taken. This method is effective, but doctors do not always have time to identify signs of pathology. Not all women are attentive to their bodies.
Conservative treatment
After a clinical examination, confirmation of the diagnosis and identification of the cause of the disease, the doctor prescribes the following medications to his patient for correction:
- vitamins, microelements;
- mild sedatives;
- drugs that relieve uterine tone (antispasmodics, tocolytics, etc.);
- fluoroquinolones or cephalosporins.
If the cause of the development of isthmic-cervical insufficiency is a hormone imbalance, the patient is prescribed hormone replacement therapy. The effect of treatment for ICI during pregnancy is aimed at restoring normal levels of biologically active substances.
The medication prescribed by the doctor should be continued for 7–14 days, after which the doctor should re-examine the patient. If the pregnant woman’s condition has not stabilized during treatment with ICN, the medication will continue. If the disease begins to progress again, the woman is offered other methods of combating the pathology.
The second way to correct the disease is to install an obstetric device (pessary). A plastic or silicone ring will support the lower segment of the uterus and redistribute the weight of the baby and amniotic fluid. The Meyer ring, as a foreign object, can cause bacterial vaginosis, so it is important to remove it every 2 days and treat it with a disinfectant. A doctor should regularly take swabs for infection in a woman. If necessary, the doctor prescribes antibiotics to the expectant mother.
Obstetric pessary during pregnancy A woman who has an obstetric pessary fitted may experience constipation. The ring, as many patients note, seems to be pinching the passage. Pregnant women should not push, so the doctor must prescribe a mild remedy so that constipation stops bothering the woman.
Doctors note that a ring pessary can be installed at any stage of pregnancy. It is this device that doctors often recommend to pregnant women to treat the early stages of the disease. However, if the pathology is already pronounced, this device will become an auxiliary tool. The ring is removed after the first 2 weeks of the 9th month of pregnancy or when labor begins.
It is important to note that during treatment, a woman needs to give up physical activity and sexual intercourse. The expectant mother should avoid stressful situations, visit the doctor regularly and rest often. One more important point is the woman's attitude. It is important to believe that doctors will help you get rid of ICN.
Surgical correction
In case of severe ICI, the doctor may insist on surgical correction - applying a horizontal, circular or seromuscular suture to the lower segment of the uterus. The operation is performed under general anesthesia at 13–27 weeks of pregnancy. Probability of birth healthy child will increase to 90%.
Before applying surgical sutures, the doctor must examine the expectant mother and take a smear from her. If necessary, the patient is prescribed treatment of the vaginal mucosa with antiseptics.
The doctor, based on the results of the tests, may refuse surgery for ICI. In particular, contraindications include:
- genetic abnormalities in the fetus;
- severe vaginitis;
- chronic diseases;
- intrauterine infection;
- bloody issues;
- complications of late toxicosis;
- violation of the muscle tone of the uterus;
- rapid development of ICN.
After the operation, which will take 15–20 minutes, the pregnant woman is prescribed the following medications according to indications:
- medications that relieve muscle spasms (Drotaverine, magnesia, etc. (we recommend reading: ).);
- medications whose action is aimed at relaxing the muscles of the uterus (Indomethacin, Ginipral, etc.);
- drugs containing hormones or hormonoids (Iprozhin, Endometrin, etc.).
During the recovery period, a woman should take care of herself and rest more often. Physical activity should be avoided.
On days 2–3 after surgery, the doctor examines the patient. If the pathology is corrected, the pregnant woman is allowed to go home.
If the operation is successful, the sutures are removed at the beginning of the 9th month of pregnancy. Otherwise, medical help may be needed if the membranes surrounding the fetus rupture, during uterine contractions, if the suture is damaged or a fistula appears, etc.
Pregnancy with ICI is a difficult ordeal. To alleviate the condition of a pregnant woman, it is important to follow the recommendations. There should be such prevention of this disease:
- refusal of physical activity;
- sexual rest;
- constant rest in a lying position;
- use of prescribed medications;
- good mood;
- frequent medical examinations.
How is childbirth with ICN?
ICI is a pathology characterized by open and weakened vaginal muscles. Women with this disease give birth faster. However, this does not mean that this will be the case for absolutely everyone. The human body is a mystery.
Isthmic-cervical insufficiency is a common cause of baby loss during pregnancy. Miscarriages occur especially often in the middle of the gestational age due to this pathology.
At the end of the baby's gestation period, ICN often leads to premature birth. What this pathology is and what correction methods exist during pregnancy, we will tell you in this material.
What it is?
The cervix performs an important function - it holds the developing baby inside the uterine cavity. The cervical canal, located inside the cervix, fills immediately after fertilization a thick mucus plug that does not allow infections and viruses to penetrate to the baby.
If the neck does not cope with the goals set for it by nature in full, they talk about isthmic-ecclesiastical insufficiency. With it, the cervix is simply not able to withstand the pressure of the growing baby and amniotic fluid, as a result of which a miscarriage, early birth can occur, and in a full-term pregnancy, childbirth with ICI can be dangerously rapid.
In a state of insufficiency, the cervix itself shortens and softens. Normally, the process of shortening and smoothing begins only before childbirth. With isthmic-cervical insufficiency, shortening occurs much earlier. The internal os expands. There is a threat of parts of the membranes falling out of the uterus and the subsequent death of the baby.
According to the observations of obstetricians and gynecologists, the pathological condition occurs in approximately 2-3% of all pregnancies. Every third woman with ICI experiences premature birth. Every second death of a child in late gestation is due to this particular reason.
Causes
There are three large groups of reasons that can lead to pathology of the cervix and isthmus.
Congenital factors
Functional factors
If the tissues of the cervix are in an incorrect balance between connective and muscle fibers, if they respond inadequately to hormonal stimulation, then the functions of the cervix are impaired. This can happen to a woman whose ovaries are depleted, the functions of the sex glands are reduced, and the content of male sex hormones, for example, testosterone, is increased in the blood.
If a woman was prepared for conception by stimulating ovulation with gonadotropic hormones, then her hormone relaxin may be increased. Under its action, the muscles of the main female reproductive organ relax. The same relaxing hormone can also be exceeded in a woman who carries several babies under her heart at the same time.
Gynecological diseases
Often the cause of cervical insufficiency lies in gynecological diseases, which for a long time were not treated and which passed into the chronic stage.
The risk of developing functional ICI increases in women who decide to become mothers after 30 years of age, in women who are overweight or obese, as well as in women who become pregnant through in vitro fertilization.
Organic factors
This is the most common cause of cervical incompetence during pregnancy. It may be associated with previous trauma to the cervix.
This usually happens during the birth process if a woman gave birth to a large child, twins or triplets naturally, and the birth was difficult. Previous ruptures cannot but affect the health of the cervix during subsequent pregnancy.
If a previous pregnancy was accompanied by polyhydramnios, if the labor process was rapid, if the placenta had to be separated manually, all this also increases the risk of cervical injury and subsequent isthmic-cervical insufficiency.
All operations that were performed with mechanical expansion of the cervix affect its subsequent condition. Such operations include abortions, curettage, including diagnostic ones, as well as cervical operations.
Symptoms and signs
The pathology has no obvious symptoms. Pregnant women often do not realize that they have a weak cervix, there are pathological changes and there is a serious danger of miscarriage. None discomfort INC is not delivered to patients.
Infrequently, at the very beginning of gestation, some symptoms of a threatened miscarriage may appear - a slight sanguineous or bloody “smear” from the vagina, minor pulling sensations in the lower abdomen and lumbar region.
Diagnostics
It is very difficult to diagnose isthmic-cervical insufficiency, since it has no obvious symptoms. A doctor may suspect something is wrong during a gynecological examination, but it is rarely performed on pregnant women. Mostly only upon registration.
However, if a woman is at risk for developing ICI, then examinations may be carried out more often. On gynecological chair with the use of obstetric mirrors and ordinary palpation, the doctor can only determine the consistency of the cervix, see the condition of the external pharynx and the condition of the cervical canal - whether it is closed or slightly open. This information is extremely insufficient to make an appropriate diagnosis.
At the very beginning of pregnancy, women are prescribed a colposcopy; during this study, using a special device - a colposcope - it is possible to obtain more information about the cervical canal and the structure of the cervical tissues. Based on the results of this examination, there may be suspicions of cervical weakness.
Ultrasound diagnostics helps to finally clarify the situation. Ultrasound allows you to measure the length of the cervix, compare it with normal average values and confirm or refute the presence of ICI.
It is reasonable to measure such a parameter as cervical length after 20 weeks, because by this time this indicator becomes important for diagnosis.
Cervical length during pregnancy - norms and fluctuations within norms:
Ultrasound is performed internally, intravaginally. This is the only way to find out the answer to the main question - what is the condition of the internal os of the cervix. If it begins to open, then the uterus on the monitor of the ultrasound scanner acquires a characteristic V-shaped appearance.
In this case, such a concept as prolapse of membranes. The bubble can protrude to varying degrees, and the assessment of the real threat to pregnancy and prognosis will depend on it.
- If the amniotic sac is located above the internal os, this is considered the most favorable prognosis. first degree of threat.
- If the bubble is already at the level of the internal pharynx, they speak of ICN 2nd degree,.
- If the bubble is already partially protruding into the cervical lumen - o ICN 3rd degree.
- The most severe degree is fourth, with it, prolapse of the amniotic sac is already in the vagina.
When making a diagnosis, the obstetric history of the expectant mother must be taken into account - how many births and abortions there were, how they went, were there any complications, what chronic diseases She has a gynecological plan. Special attention will pay attention to the facts of habitual miscarriage, if each pregnancy was terminated earlier than the previous one.
If in pregnant women who are not at risk for the development of isthmic-cervical insufficiency, cervical examinations using ultrasound waves are carried out simultaneously with prenatal screening at the beginning of pregnancy, in the middle and in the third trimester, then for women with ICI or prerequisites for the occurrence of such insufficiency You will have to visit the ultrasound room a little more often.
Danger and complications
The main and most dangerous complication of cervical insufficiency is the loss of the long-awaited baby at any week of gestation. Miscarriage or premature birth in this case develops rapidly and quickly.
Quite often it all begins with the discharge of amniotic fluid, and it can be either complete or partial. Excessive watery discharge may indicate water leakage.
Often, isthmic-cervical insufficiency leads to infection of the fetus inside the mother’s womb, because the cervical canal, normally tightly closed, opens slightly, and there are practically no barriers to pathogenic bacteria and viruses. Intrauterine infection is dangerous for the development of the baby; it can lead to the birth of a child with severe pathologies, diseases, and also to the death of the child before birth.
Treatment
The treatment regimen depends on the degree and characteristics of cervical insufficiency in a particular woman. In some cases, it is possible to manage with drug therapy; it is often necessary to resort to surgical correction.
Surgical methods of correction
Stitches on the cervix help bring the baby to term. The operation is strongly recommended for women suffering from chronic miscarriage in both early and late stages, as well as premature shortening of the cervix.
The operation is contraindicated if the expectant mother has chronic gynecological diseases, heavy bleeding, if the uterus is in a state increased tone and it cannot be eliminated with medications.
It is customary to place sutures on the cervix from 14-15 weeks to 20-22 weeks. Application after 22 weeks is considered inappropriate. The child is growing rapidly, the walls of the uterus are stretched, suturing may result in cutting of stitches and rupture of tissue.
The surgical technique is quite simple. Manipulations are carried out under anesthesia - general or epidural. The dosage of drugs for medicinal sleep and pain relief is selected by the anesthesiologist, taking into account the “interesting position” of the patient, so as not to harm the baby. Stitches can be placed on the external or internal pharynx.
Before surgery, a woman must undergo a thorough examination for infections and, if necessary, treatment for an existing infection.
Only when they are sure that there is no inflammatory process in the uterine cavity will surgeons begin to suture the cervix.
After the stitches are removed, and this happens at 36-37 weeks or earlier, if the situation requires it, labor can begin within a short time. The cervix can be seriously damaged if labor has already started and the stitches have not yet been removed. Therefore, it is recommended that women with stitches on the neck go to the hospital in a maternity hospital in advance.
Conservative treatment options
One of the most common ways to correct isthmic-cervical insufficiency is the installation of an obstetric pessary. This method is widely used when a woman has functional deficiency from 14-15 weeks to 32-34 weeks of pregnancy.
A pessary is a rubber or latex ring that is placed on the cervix so that its edges rest against the walls of the vagina. This allows you to keep the cervix in a stable position, and the load on it, which is exerted by the baby growing in the uterus, is significantly reduced.
A pessary is not applied if the cervical canal is slightly open. In this case, stitches are applied, and in addition to surgical method A pessary can also be used.
The pessary, like the sutures, is removed before childbirth in a hospital setting. Pregnant women often wonder whether the cervix can lengthen after applying a pessary. Lengthening does not occur as such, but the risk of miscarriage after installation of the fixation ring is significantly reduced.
Conservative treatment also includes taking medications. On initial stage a woman diagnosed with cervical incompetence is treated with antibiotics and "Dexamethasone" The doctor selects specific antibacterial drugs. This helps reduce the likelihood of intrauterine infection of the baby.
Drugs that relieve the tone of the uterine muscles help reduce the pressure inside the uterine cavity. For this purpose, a woman is prescribed "No-shpu", "Papaverine". If these drugs in tablets, injections or suppositories do not help, the woman may be prescribed "Nifedipine".
Hormonal therapy is used to prevent miscarriage - "Duphaston", "Utrozhestan" in an individual dosage and according to an individual regimen, sometimes up to 34 weeks of pregnancy.
You should take the medications prescribed by your doctor strictly, without violating the dose or frequency, and without missing the next dose.
Prevention
The best prevention of isthmic-cervical insufficiency is considered to be pregnancy planning. If you consult a gynecologist not after the fact of pregnancy, but even before it occurs, with a high degree of probability the doctor will be able to tell whether the woman is at risk of pathological cervical dysfunction.
The doctor inserts a special dilator into the cervix and measures the width of the internal pharynx. It is advisable to do this on days 19-20 of the cycle.
If there are no problems, then the internal pharynx has normal dimensions (within 2.5 mm). If pathological expansion is present, this number will be exceeded. The most unfavorable is considered to be a size of the internal pharynx greater than 6-7 mm.
A woman who wants to carry her to term normally and give birth to her baby on time should not have abortions or curettage unless there is an urgent medical need. To do this, you should approach the issues of contraception responsibly at the onset of sexual activity.
All gynecological diseases need to be examined and treated in a timely manner, without “running” into a chronic condition.
Women who are usually taken by surprise by the diagnosis of “isthmic-cervical insufficiency” are advised to seek help from a psychologist who is seen at every antenatal clinic. This specialist will be able to give them the right attitude and will explain that this diagnosis is not a death sentence, and in most cases such pregnancies end quite happily with the birth of a healthy baby at term.
The psychological mood of a pregnant woman is of great importance during treatment, because stress affects the hormonal background and increases the tone of the uterine muscles, which makes it difficult for doctors.
Physical activity should also be reduced to the point of complete limitation - in case of a serious threat, bed rest helps. Women with a lower risk level are prohibited from long walks, as well as lifting anything heavier than 2 kilograms.
The longer the pregnancy, the more attention a woman should pay to her position in space. You cannot sit or stand for a long time, this increases the pressure in the uterine cavity, and the load on the cervix increases significantly.
A woman should also lie down correctly - on your back with your legs slightly elevated. To do this, you can put a small pillow or cushion under them, this will help reduce uterine pressure.
From 24-26 weeks of pregnancy, weekly monitoring of the condition of the cervix is needed. After 30-31 weeks, a woman may be indicated for preventive hospitalization, since a large number of premature births occur during this period.
At 37 weeks, you need to go to the hospital in advance, since labor with ICI often progresses quickly. Without constant monitoring expectant mother very negative consequences can occur.
A woman with cervical insufficiency should not make love.
If pain appears in the lower abdomen, atypical discharge, you should immediately consult a doctor. This does not mean that premature birth or miscarriage has begun, but in this matter it is always better to be safe.
– a disorder associated with the opening of the cervix during embryogenesis, which leads to spontaneous abortion or premature birth. Clinically, this pathology usually does not manifest itself in any way; sometimes minor pain and a feeling of fullness, and the release of mucus and blood are possible. Ultrasound scanning is used to determine pathological changes and confirm the diagnosis. Health care consists of installing a Meyer ring (special pessary) in the vagina or surgical suturing. Drug therapy is also indicated.
General information
Isthmic-cervical insufficiency (ICI) is a pregnancy pathology that develops as a result of weakening of the muscle ring located in the area of the internal os and unable to hold the fetus and its membranes. In obstetrics, this condition occurs in every tenth patient, usually occurs in the second trimester, and is less commonly diagnosed after 28 weeks of pregnancy. The danger of isthmic-cervical insufficiency lies in the absence of early symptoms, despite the fact that this pathological condition can lead to fetal death in the later stages or the onset of premature birth. If a woman experiences recurrent miscarriage, in about a quarter of clinical cases the cause of this condition is ICI.
With isthmic-cervical insufficiency, there is a decrease in muscle tone in the area of the internal pharynx, which leads to its gradual opening. As a result, part of the membranes descends into the lumen of the cervix. At this stage, isthmic-cervical insufficiency poses a real threat to the child, since even a slight load or active movements can cause a violation of the integrity of the amniotic sac, subsequent premature birth or fetal death. In addition, with ICI, infection can be transmitted to the fetus, since a certain microflora is always present in the genital tract.
Causes of isthmic-cervical insufficiency
The etiology of isthmic-cervical insufficiency is a decrease in the tone of the muscle fibers that form the uterine sphincter. Its main role is to maintain the cervix closed until labor occurs. With isthmic-cervical insufficiency, this mechanism is disrupted, which leads to premature opening of the cervical canal. Often the cause of ICI is a history of traumatic injuries to the cervix. The likelihood of developing isthmic-cervical insufficiency increases in women who have suffered late abortions, ruptures, or surgical births (application of obstetric forceps).
Isthmic-cervical insufficiency often occurs after fetal destruction operations, breech birth and surgical interventions on the cervix. All these factors cause trauma to the cervix and possible violation the location of muscle fibers relative to each other, which ultimately contributes to their failure. Also, the cause of isthmic-cervical insufficiency can be congenital anomalies associated with abnormal structure of organs reproductive system pregnant woman. Congenital ICI is quite rare, and can be determined even in the absence of conception - in such a case, at the time of ovulation, the cervical canal will dilate by more than 0.8 cm.
Isthmic-cervical insufficiency is often observed against the background of hyperandrogenism - an increased content of male sex hormones in the patient’s blood. An increase in the likelihood of developing pathology is observed when this problem is combined with a deficiency of progesterone production. An aggravating factor for isthmic-cervical insufficiency is multiple births. Along with increased pressure on the cervix, in such cases an increase in the production of the hormone relaxin is often detected. For the same reason, isthmic-cervical insufficiency is sometimes diagnosed in patients who have undergone ovulation induction with gonadotropins. The likelihood of developing this pathology increases if you have large fruit, polyhydramnios, presence in the patient bad habits, performing heavy physical work during pregnancy.
Classification of isthmic-cervical insufficiency
Taking into account the etiology, two types of isthmic-cervical insufficiency can be distinguished:
- Traumatic. Diagnosed in patients with a history of operations and invasive manipulations on the cervical canal, resulting in scar formation. The latter consists of connective tissue elements that cannot withstand increased load due to fetal pressure on the cervix. For the same reason, traumatic isthmic-cervical insufficiency is possible in women with a history of ruptures. ICI of this type manifests itself mainly in the 2-3 trimester, when the weight of the pregnant uterus rapidly increases.
- Functional. Typically, such isthmic-cervical insufficiency is provoked by a hormonal disorder, caused by hyperandrogenism or insufficient production of progesterone. This form often occurs after the 11th week of embryogenesis, which is due to the beginning of the functioning of the endocrine glands in the fetus. The endocrine organs of the child produce androgens, which, together with substances synthesized in the woman’s body, lead to a weakening of muscle tone and premature opening of the cervical canal.
Symptoms of isthmic-cervical insufficiency
Clinically, isthmic-cervical insufficiency, as a rule, does not manifest itself in any way. If symptoms are present, the signs of pathology depend on the period at which the changes occurred. In the first trimester, isthmic-cervical insufficiency may be indicated by bleeding, not accompanied by pain, in rare cases combined with minor discomfort. In the later stages (after 18-20 weeks of embryogenesis), ICI leads to fetal death and, accordingly, miscarriage. Bleeding occurs and discomfort in the lower back and abdomen is possible.
The peculiarity of isthmic-cervical insufficiency is that even with a timely visit to an obstetrician-gynecologist, due to the lack of obvious symptoms, it is not easy to identify pathological changes. This is due to the fact that an objective gynecological examination is not routinely performed during each consultation in order to reduce the likelihood of introducing pathogenic microflora. However, even during a gynecological examination, it is not always possible to suspect manifestations of isthmic-cervical insufficiency. The reason for instrumental diagnostics may be excessive softening or reduction in the length of the neck. It is these symptoms that often indicate the onset of isthmic-cervical insufficiency.
Diagnosis of isthmic-cervical insufficiency
Ultrasound scanning is the most informative method in identifying isthmic-cervical insufficiency. A sign of pathology is shortening of the cervix. Normally, this indicator varies and depends on the stage of embryogenesis: up to 6 months of pregnancy it is 3.5-4.5 cm, in later stages - 3-3.5 cm. With isthmic-cervical insufficiency, these parameters change downward. The threat of interruption or premature birth of the baby is indicated by a shortening of the canal to 25 mm.
V-shaped neck opening – characteristic feature isthmic-cervical insufficiency, which is observed in both parous and nulliparous patients. This symptom can be detected by ultrasound monitoring. Sometimes, to confirm the diagnosis during scanning, a test with increasing load is performed - the patient is asked to cough or lightly presses on the bottom of the uterine cavity. In women who have given birth, isthmic-cervical insufficiency is sometimes accompanied by an increase in the lumen of the cervix along its entire length. If a woman is at risk or has indirect signs of ICI, monitoring should be carried out twice a month.
Treatment of isthmic-cervical insufficiency
In case of isthmic-cervical insufficiency, complete rest is indicated. It is important to protect a pregnant woman from negative factors: stress, harmful working conditions, intense physical activity. The question of the conditions for subsequent pregnancy management is decided by the obstetrician-gynecologist, taking into account the patient’s condition and the severity of pathological changes. Conservative care for isthmic-cervical insufficiency involves installing a Meyer ring in the vagina, which reduces fetal pressure on the cervix. The procedure is recommended to be carried out during the embryogenesis period of 28 weeks or more with a slight opening of the pharynx.
Surgical intervention for isthmic-cervical insufficiency makes it possible to carry the baby to the required period. The manipulation involves placing a suture on the neck to prevent its premature opening. The operation is performed under anesthesia; to perform it you need following conditions: signs of the integrity of the membranes and the vital activity of the fetus, gestational age up to 28 weeks, absence of pathological discharge and infectious processes from the genital organs. Sutures and pessaries for isthmic-cervical insufficiency are removed upon reaching the embryogenesis period of 37 weeks, as well as in the event of labor, opening of the amniotic sac, formation of a fistula, or bleeding.
During conservative therapy and in the postoperative period, patients with isthmic-cervical insufficiency are prescribed antibacterial drugs to prevent the development of infection. The use of antispasmodics is also indicated, and tocolytics for hypertonicity of the uterus. In the functional form of isthmic-cervical insufficiency, hormonal agents can be additionally used. Delivery is possible through the vaginal genital tract.
Forecast and prevention of isthmic-cervical insufficiency
With isthmic-cervical insufficiency, a woman can carry the baby to the expected date of birth. Due to a weak muscular sphincter, the risk of rapid labor increases; if there is a possibility of developing this condition, pregnant women are hospitalized in the obstetric department. Prevention of isthmic-cervical insufficiency involves timely examination and treatment of identified diseases (especially hormonal ones) even at the stage of planning conception. After fertilization, the patient must normalize her work and rest schedule. It is important to exclude stress factors and hard work. Specialists should closely monitor the woman’s condition and determine as early as possible whether she is at risk for developing ICI.
